Urology/problems

QuestionQUESTION: I have two problems. First of all, I suffered pain and discomfort in my testicle for over a year and it finally went away for a number of months. I thought that was the end of it but suddenly I am again feeling some discomfort in the same testicle. It is not pain but it is an unpleasant feeling. I worry that it could eventually progress and become painful again like last time. I dont want to wait another year before it goes away but it does sound to me like chronic epididimitis. It is said to come and go and eventually burn out.
Am I right? you said it would never go away but it did. why has it suddenly got worse again?

Secondly my ejaculation is weak. It didnt use to be weak. It was strong. Now it sort of dribbles out. How do I mend this? why has it gone weak?

i am still young and this is totally unacceptable.

ANSWER: Jim:

Chronic epididymitis is a type of long term inflammation. This usually heals slowly over time with scar tissue and this scarring tends to cause the pain. It does not disappear on it's own. It's possible that the inflammation died off and now was re-irritated by another infection, prostatitis or trauma. Chronic epididymitis may or may not eventually die out. Check with a local urologist to see what can be done. In many cases, when medications don't help very much, we do a surgical exploration of the testicle and in some of these cases we surgically remove the testicle to help deal with the pain. Let's hope it doesn't come to that.

Weak ejaculation can indicate prostatitis or be a side effect from medication. There is probably no way you can "mend" this on your own. Please consult a urologist.

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QUESTION: so how come the pain went away? if it was scar tissue wouldnt the pain persist?
why dont you cut the nerve instead of removing the whole testicle? nobody would do such a stupid thing as removing a healthy testicle just to reduce a bit of mild pain. Im sure you would rather live with mild pain than live without pain or a testicle.

Im not on medication so that is not relevant.

what is a surgical exploration? there is no way to explore the testicle properly unless you do biopsies or more invasive tests.

i think more research is what we need. Surgery is basically a primitive way to solve problems. Cutting things off when we dont know what is wrong, is never the answer.

AnswerJim:

I can't explain why the pain went away. Perhaps some low grade infection finally healed or there was some stretching in the scar tissue which temporarily relieved the pain until the scar tissue contracted again over time. We would expect the pain the continue if due to scar tissue.

There is no single nerve to cut but sometimes we can try to denervate the cord. However, this does not always work.

Sometimes the pain is from visceral (tissue) sources and the actual cause of the pain is from a tissue effect on the nerves.

Trying to fix chronic testicular pain can be very difficult as it gets complicated.

Look at it this way. There are only limited ways to investigate a testicular problem: direct examination by a specialist and a scrotal ultrasound are the most commonly used. Trials of various medications such as antibiotics and anti-inflammatories are often used. If these measures fail, then consideration can be given to a spermatic cord block with local anesthetic. If this eliminates the pain, then you have good information that the source is the testicle and an exploration becomes reasonable.

At a surgical exploration, the testicle can be completely examined without the coverings that make it difficult to detect small abnormalities like cysts and scarring. If these are found, they can be fixed surgically. If not, then your only choice is to remove the testicle or leave it and allow the pain to continue. While this almost always solves the pain, it is not guaranteed so it'a a gamble.

Since you believe that surgery is not the answer for you, I wish you good luck in getting your problem resolved.

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

PublicationsMen's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/CredentialsGraduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and HonorsThirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute